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Comprehensive Diabetes Care: Diabetic HbA1c Test with Controlled Result

Advantage MD, EHP, Priority Partners/VBP, and USFHP. Members 18-75 years of age.

  • Percentage of members with diabetes (type 1 and type 2) who had the following:
    • Hemoglobin A1c (HbA1c) testing
    • HgA1c poor control (>9.0%) *,**
    • HgbA1c control (<8.0%)
  • An HbA1c test performed during the measurement year, as identified by administrative data or medical record review. The most recent = closest to December 31 of measurement year.
  • The member is only compliant if the most recent HbA1c result is < 8.0 for EHP, Priority Partners/VBP and USFHP.

* For Advantage MD members a result < 9.0 is acceptable. At a minimum, documentation in the medical record must include a note indicating the date when the HbA1c test was performed and the result.
** This is an inverse measure; the goal is to be less than 9.0%

Best Practice and Measure Tips

  • If multiple tests were performed in the measurement year, the result from the last test is required.
  • Since the last value in the year is used, have member repeat elevated test prior to the end of the year.

Acceptable terminology:

  • A1c, HbA1c, HgbA1c
  • Glycohemoglobin
  • Glycohemoglobin A1c
  • Glycated hemoglobin
  • Glycosylated hemoglobin
  • Hemoglobin A1c
  • Always list the date of service, result and test together.
  • If test result(s) are documented in the vitals section of your progress notes, please include the date of the blood draw with the result. The date of the progress notes will not count.
  • Schedule labs prior to patient appointments to assist with compliance.
  • Adjust therapy as indicated to improve A1c levels.

Not Acceptable: Self tested when not processed by a lab. Documentation of ranges and thresholds do not meet criteria. Example: < 9.0%.

Measure Exclusions

Required Exclusions:

  • Palliative Care
  • Hospice
  • Fraility
  • Fraility and Advanced Illness
  • Living in Long Term Care

Optional Exclusion: Members without a diagnosis of diabetes in any setting and a diagnosis of polycystic ovarian syndrome, gestational diabetes or steroid-induced diabetes during the measurement year or the year prior

Measure Codes

  • HbA1C Lab Test
    • CPT: 83036, 83037
    • CPT-CAT-II: 3044F, 3045F, 3046F
  • HbA1c Level Greater than/Equal to 7 and Less than 8
    • CPT-CAT-II: 3051F
  • HbA1c Level Greater than/Equal to 8 and Less than/Equal to 9
    • CPT-CAT-II: 3052F
  • HbA1C Greater than 9.0
    • CPT: 83036, 83037
    • CPT-CAT-II: 3046F